Medial collateral ligament injuriesANATOMY&FUNCTION.

Diagnosis

• The medial collateral ligament injury is most commonly an avulsion from the femoral side but mid substance and tibial avulsion tears are also

seen .

The severity of laxity of this medial collateral ligament may be described as :

•Grade I - A hint of laxity•Grade II - Definite opening of the medial joint line -

no more than 1 cm by clinical assessment or strain radiography.

•Grade III - Severe opening of the medial joint line more than 1 cm.

Conservative managment for a mild MCL injury

• grade I and mild grade II

• Week 0-1

• PRICE

• partially weight bearing

. Electrotherapy

.Active flexion/extension exercises begin as soon as pain allows.( Inner range quadriceps)

Week 1-2 • fully weight• Electrotherapy • gentle localized

massage over the injury site.

• Closed kinetic chain exercises

• Closed kinetic chain exercises

• proprioceptive balance

Week 2-3• The athlete continues with localized pressure

massage. All gym work and strengthening exercises are progressed, with emphasis on strength and power. Balance boards and agility work on the mini-trampoline. Light jogging and skipping is allowed.

Week 3-4 • Running distances and speed are increased.

Sports skills and plyometric work are gently introduced. Proprioceptive work continues with harder and more prolonged tasks.

Week 4 onwards• Athletes must practice sports skills, progressing

over 2 weeks. Athletes normally return to sport between 4-6 weeks.

Conservative managment for a moderate to severe MCL injury

• (severe grade II and grade III):

• The moderate to severe MCL injury must be protected in a hinged brace for 6 weeks to allow full healing of the ligament and reduce the risk of laxity following the injury. Patients need to be warned that the injury will be very painful, especially when working into extension.

Week 0-2• non weight bearing on crutches .

• A hinged brace is worn for support and protection.

• NSAID’s as used as necessary .

• PRICE .

• neuromuscular electrical stimulation .

• Gentle range of movement exercises .

• Thera-Band

• stretching

Week 2-4

• partially weight bearing • Electrotherapy• Closed kinetic chain exercises • quadriceps and hamstring strengthening

Closed kinetic chain exercises

Week 4-6

• fully weight bearing but still braced. Electrotherapy and massage continue.

• knee bends

• isotonic strengthening of quadriceps

• hamstrings

• single leg calf raises,

• and balance exercises on one leg.

Week 6-8 • The brace is removed.

• patellofemoral joint must be mobilized appropriately using manual techniques.

• Frictions over the scar tissue may be necessary plus the use of laser or ultrasound.

• static bike,. Progressive strengthening of quadriceps, hamstring, and calf muscles is undertaken

Week 8 onwards • isotonic and isokinetic strengthening

exercises.

• stair-master

• balance work, skipping, agility work, and full knee bend exercises

• Jogging can be initiated, progressing to running, sprinting, figure of eight running, shuttle runs, Sports training and drills start at 10 weeks onwards and the aim is a return to sports by approximately 12 week.